This is a little late in the making, but I took the second half of last week off after HIMSS to explore Louisiana with family. I’ve always been fascinated by New Orleans and Cajun country and my days in western Louisiana last week did not disappoint. How can you beat alligators, boiled crawfish by the pound, Cajun music and dancing (at breakfast, no less), Tabasco, and more boudin than you could ever eat? My brother-in-law spent about three years living in Lafayette and working as an engineer on offshore oil rigs, so we had the bonus of an informed tour guide.

Honestly, my first impression is that HIMSS as an event is just way to overwhelmingly large to be manageable. HIMSS doesn’t want this, but they should cut out all the educational stuff and just call it what it is, a massive networking event that’s really the only time you can meet with so many different people in health and health technology in one place. And please start limiting the size of vendor booths so that the exhibit hall doesn’t feel like its own ZIP code.

I was only at HIMSS for a couple of days, but I don’t think I could’ve survived any more than that. Just look at my activity for Tuesday (shown below).

That 6,100 Fuel and 23,000 steps was not discomfort, especially since it was all in business casual attire. I can’t even calculate how much time I spent running from the press room to some part of the exhibit floor to the HIMSS offices and around and around. At least I didn’t break down and take the trolley in the exhibit hall. It is a health conference, right?

Now back to the event itself and the themes that everybody — at least the people I was talking to — were talking about. The two main themes were that: 1) EMRs were only the starting point for really interesting technology to be layered on top, and 2) somebody now needs to figure out how to optimize care around these new technologies, something that’s been missing as we’ve rushed to implement technology and meet Meaningful Use.

EMRs as Concrete

Current EMRs are not built to improve the actual care delivery process. Sometimes I wonder what current EMRs are built for at all. It’s not to say that conceptually they don’t make sense or add value. I just think the designs and implementations we have suck.

Case in point: my wife spends 2-3 hours every night in Epic mindlessly entering data about patient visits from her day. She is painfully aware that her entries will very likely never been used or even seen, and if they are used in the future, it will be an incredibly inefficient process to extract any meaningful information from the notes. It’s important to point out that all of her patients have been seen, scripts have been written or sent, care instructions have been issued, referrals have been done, and everything else related to care has been completed. What’s left is documenting for legal and financial reasons, not care delivery.

Because we over-document in unfriendly systems, most docs I talk to feel obligated to look back through the maze of notes, because since there is documentation, they can’t afford to miss anything. The overwhelming majority of time, no useful information is gained from these documentation reviews. That process takes away doctor-patient time, which is already at a premium.

It’s not a new theme to think of EMRs as platforms, enabling innovative and disruptive services and apps to be built on top of them. EMR companies, at least some of them, get this and are opening up access to developers and partners. That’s fantastic. It’s great progress. It’s desperately needed. Lots of questions remain, but it’s a start.

I think the best line I heard at HIMSS was that a health system’s EMR was like a $3 billion layer of concrete. That’s some seriously over-priced concrete! My big fear is that current EMRs may not be the foundation we should be building on, and that concrete analogy falls apart if the platform isn’t up to the task. Of course we are where we are, the metaphorical train has definitely left the station, so we’ll have to wait and see how current EMRs stack up as platforms in the short to medium term. I’m holding out hope, and I spoke with several awesome people at HIMSS that gave me confidence that change is on the way.

I’d love to know what others think about our current EMRs as platforms for the future of health technology, mobile and connected included.

Optimization

Optimization relates pretty closely to EMRs as concrete. You can tell I’m not a big believer in EMRs as efficiency tools, at least today. As was pointed out to me at HIMSS, you buy an EMR, you buy a clinical workflow. You don’t buy an EMR or clinical system enable your current workflow or to optimize your workflow. Workflow optimization is definitely out of my area of focus and I’m betting most readers know much more about this area than I do so I’d love to hear thoughts on optimization, especially as it relates to our current systems.

Mobile at HIMSS

This post doesn’t really focus on mobile because my impression is that other themes trumped it. Yes, lots of companies had lots of mobile offerings and announcements — EMRs, Quest/labs, messaging, pharmacies, decision support, and publishing – but mobile had its place at HIMSS as a channel, not as a product.

One exception that I’m excited about is Me-Visit. It’s a new service that providers can register with, set a price, and start doing mobile virtual visits with patients. Patient data is captured and stored in a PHR. It includes a medical library of canned patient education for common conditions, allows voice or video, is cash-based, and is all mobile. Very smart service.

One other thing. It was funny to be at HIMSS and have my wife meet me from her big annual clinical conference for dermatology. She obviously knows my interests and shares some of them, so she sought out and made note of what she thought was cool health tech, specially connected health stuff. After talking to her, I felt like her conference would have been as interesting as HIMSS from a connected health perspective. Talking to her also made me realize how disconnected some of health technology is from clinical medicine and practice. That separation might not end well for either side, but especially for patients who are going to be sitting in the middle without their own conference.

On an unrelated note, for all those writers out there, I strongly encourage you to check out a new writing web app called Draft. I love it, though I’m hoping it will soon add features to automatically export drafts to publishing platforms like WordPress and Tumblr. It connects to Google Drive and Evernote and uses Markdown for formatting, all very nice features.